DEMOGRAPHIC FACTORS CONTRIBUTING TO THE OCCURRENCE OF VESICO
VAGINAL FISTULA
Demographic Factors
Age
In some communities women are usually given in marriage at a very early age, sometimes before
menarche, and thus start bearing children even before physical development is complete. This
too contributes to cephalo-pelvic disproportion. Since many of the girls are married off early,
fistula more often occurs in the first pregnancy. In the review by Tebeu et al. (2012),
primiparous status was present in most of the patients.
In one systematic review, majority of fistula patients were teenagers at time of management
(Tebeu 2012). Sub-Saharan Africa has the highest level of adolescent childbearing, with more
than 50% of women giving birth before the age of 20. In Latin America and the Caribbean, the
rates typically range from 50 to 100 births per 1000 women. In South-East Asia, Bangladesh has
the highest level of fertility among adolescents: 144 births per 1000 women (WHO, 2007).
Marital status
Vesico virginal fistula affects women who are married. Women were significantly more likely
not to be married after the fistula developed than they were beforehand; marital status changed
little at follow-up. Just over one-quarter of women reported that they were divorced at admission.
Rates range across countries. Nearly, all divorced women said that fistula contributed to their
divorce. Greater proportions of women from Bangladesh and Guinea, who were the oldest
women in this cohort, were widowed (Landry et al., 2013).
Gender inequality
Obstetric fistula is a condition exclusive to women and gender has a big role in its genesis.
Gender inequality and oppression of women are known to persist in regions where obstetric
fistula occurs. Gender power imbalance has also been associated with obstetric fistula (Roush
2012).
Often a woman’s role in family life centers around a strong obligation to satisfy the sexual needs
of her husband and to provide him with offspring (WHO, 2006). There are gender norms that
require women to seek approval from their husbands before seeking medical care during labour.
This makes them vulnerable to VVF.
Inadequate ANC for pregnant women
Inadequate or lack of antenatal care (ANC) was seen as a contributing factor to the occurrence of
VVF among women. Most women will then opt for home delivery. Most likely as a result of
home delivery, the mean duration of labor among the fistula patients ranged from 2.5 to 4 days.
Majority of women had labored for more than 24 hours in the review by Tebeu et al. (2012).
Failure to intervene urgently subsequently leads to pressure necrosis of the soft tissues. This may
be due to delays in getting to a health facility that is able to offer comprehensive emergency
obstetric care or failure to use a partograph in monitoring labour progress (Tebeu 2012).
A study of Zambian women indicated that lack of ANC or not being able to afford this was
contributing to VVF (Mukuma & Kasonka, 2003). Human resource limitations that included
nursing shortages and inadequate supportive supervision contributes to poor ANC that eventually
add on VVF prevalence rates (UNFPA, 2004).
Education of the Mother
The level of education of the woman can determine the prevalence rate of vesico vaginal fistula.
Lack or little knowledge on importance of maternal care and lack of knowledge to recognize the
signs of VVF will always result to high vulnerability of pregnant mothers to vesico vaginal
fistula and result to more complications during childbirth. Due to high illiteracy rates and a lack
of information and education there may be a failure to perceive the severity of the condition
(Ahmed & Holtz, 2007)
Education of the Spouse
Illiteracy and lack of education of the husband about reproductive health, including family
planning, nutrition and safe maternity care is one of the causes of VVF in women (Roush, 2012).
A study by Abdelgadir & Abdalla (2008) indicated that illiterate husbands knew nothing about
the nature of VVF complications and need for better maternal care for their wives. This situation
was the opposite in those women whose husbands were educated, as most of them were neither
divorced nor maltreated (Abdelgadir & Abdalla, 2008).
Parity
Since many of the girls are married off early, fistula more often occurs in the first pregnancy. In
the review by Tebeu et al. (2012), primiparous status was present in few of patients while
multiparous women tend to be vulnerable to vesico vaginal fistula than primiparous women.in a
stud by Wall & Karshima (2004) on multiparous showed that more than half of the women had
VVF.
Target population
The target population in this study was 200 women who have successfully undergone VVF
repair at Kenyatta National Hospital. The accessible population was that available in the repair
centre during the time of study.
3.4 Inclusion criteria
The inclusion criteria was included all the women who have undergone successful repair who
gave consent to the study.
Exclusion criteria
Exclusion criteria was included all the women who have undergone successful repair but did not
give consent to the study.
Sampling technique
Convenient sampling was used to select the respondents and interviewed using the questionnaire.
Convenience sampling involves choosing respondents at the convenience of the researcher. This
method of sampling is employed by researchers because the time and cost of collecting
information can be reduced.
Sample size
The sample size consisted of all women who have been repaired of VVF that were admitted to
Kenya National Hospital during the time of the study. The sample size for this study was
calculated based on obstetric fistula rate of 1/1000 women in Kenya. The sample size was 131
The sample size was calculated using Fisher et al (1998) formula which is as follows: , where is
the standard normal deviate = 1.96 for a 95% level of significance, 50% is the prevalence rate
from other studies, and 0.05 is the degree of accuracy. Therefore,
n=z2p(1−p)
d2
Where:
n= sample size;
z= the table value for the level of confidence, 95% level of confidence (1.96)
d= margin of error (0.05)
p= proportion to be estimated, Israel (1992) recommends that if you don’t know the value of p
then you should assume p=0.5
n=1 . 9620 .5 (1−0 .5 )
0. 052=384
n=384
Since our target population is below 10,000 a sample size of 384 calculated from the first
formula was discarded and another formula used that takes care of population of less than
10,000. Therefore the sample size was subjected to Yamane (1967) formula by Yamane which is
recommended for a population below 10,000. Using this formula our new sample size was 131
successful repairs. Therefore N= 200 which is the target population of patients who have
undergone successive repairs.
nf =
(
n
1+n
N
)
nf =
(
384
1+384
200
)
=131
Sample size of 131 VVF repaired patients was used.
Demographic Data
Marital Status
The study sought to establish the marital status of the respondents. The results recorded in table
4.1 below for interpretation purposes.
Table 4.1: Marital Status of the respondents
No of members n=118 Percentage
Single 16 14%
Married 79 67%
Divorced 11 9%
Separated 10 10%
Total 118 100%
The study in table 4.1 illustrates that 14% of the respondents were single, 67% were married, 9%
were divorced while 10% were separated.
Level of Education
The results for respondents’ highest level of education were recorded below.
Table 4.2 Level of Education
No of members n=118 Percentage
Informal 16 14%
Primary level 72 61%
Secondary level 18 15%
Tertiary level 12 10%
Total 118 100%
The results from table 4.2 above illustrates 14% (n=16) had informal level of education, 61%
(n=72) had primary level of education, 15% (n=18) had secondary level of education while 10%
(n=12) had tertiary level of education.
Place of delivery
The researcher had to find out where the respondents had delivered their children.
Figure 4.1 Place of delivery
Home Hospital Clinic
0%
10%
20%
30%
40%
50%
60%
20%
55%
25%
Respondents’ results show that 20% delivered from home, 55% from hospital while only 25%
from clinic as illustrated from figure 4.1 above.
Level of your Husband’s Education
The results below shows the level of respondent’s Husband’s Education
Table 4.2 Level of your Husband’s Education
5 No of members n=118 Percentage
Informal 16 14%
Primary level 25 21%
Secondary level 65 55%
Tertiary level 12 10%
Total 118 100%
Respondents’ husbands that had informal level of education were represented by 14 %(n=16),
those with primary level were 21%(n=25), secondary level were 55% (n=65) while tertiary level
were 10% (n=12) as illustrated in table 4.2 above.
Antenatal Visits
The study had to find out the number of antenatal visits the respondents had during their previous
pregnancy.
Figure 4.2 Antenatal Visits
10%
15%
54%
21%
One
Two
Three
Four
The study shows that 10% had made antenatal visit once, 15% had made twice, 21% had made
four times while the majority 54% had made thrice as illustrated in figure 4.2 above.
Socio-Cultural Factors
This section seeks to examine the effect of socio-cultural factors on the prevalence of VVF in
Kenya.
FGM practice
The study sought to find out whether the respondents had undergone FGM practices. The results
were recorded in figure 4.3 below.
Figure 4.3 FGM practice
Yes No
0%
10%
20%
30%
40%
50%
60%
70%
80%
25%
75%
The results shows that 25% had undergone FGM practice while 75% had not as illustrated in
figure 4.3 above.
Sexual violence and VVF
Respondents’ response on the extent sexual violence can cause VVF
Table 4.3 Sexual violence and VVF
J
No of members n=118
Percentage
Great extent 16 14%
Moderate extent 64 54%
Low extent 20 17%
Total 118 100%
The study shows that 14% (n=16), agreed to a great extent, 54% (n=64) to a moderate extent
while 17% to a low extent that sexual violence can cause VVF as indicated in table 4.2 above.
Abortion and VVF
The study had to find out the extent the respondents thought abortion can cause VVF.
Figure 4.4 Abortion and VVF
62%
25%
13%
Great extent
Moderate extent
Low extent
The study shows that 13% agreed to a low extent, 25% to a moderate extent while 62% to a great
extent that abortion can cause VVF as illustrated in figure 4.4 above.
Superstitions and vesico vaginal fistulas
The researcher had to find out believes and superstitions contribute to vesico vaginal fistulas.
Figure 4.5 Superstitions and vesico vaginal fistulas
Yes No
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
10%
90%
The results shows that only 10% agreed while the majority 90% disagreed that believe and
superstitions contribute to vesico vaginal fistulas as illustrated in figure 4.5 above.
Discussion
Demographic Factors
The findings indicated that giving birth at a young age contributes to cephalo-pelvic
disproportion as a result of incomplete physical development. This result agrees with Tebeu et al.
(2012), primiparous status was present in most of the patients. Findings on marital shows that
Vesico virginal fistula affects women who are married than who are not married. These findings
were in line with (Landry et al., 2013) who posits that Greater proportions of women from
Bangladesh and Guinea, who were the oldest women in this cohort, were widowed.
The study further indicated that there are gender norms that require women to seek approval
from their husbands before seeking medical care during labor. This makes them vulnerable to
VVF. These results agree with (Roush 2012) who agrees Obstetric fistula is a condition
exclusive to women and gender has a big role in its genesis. Gender inequality and oppression of
women are known to persist in regions where obstetric fistula occurs. Gender power imbalance
has also been associated with obstetric fistula.
The study further showed that inadequate or lack of antenatal care (ANC) was seen as a
contributing factor to the occurrence of VVF among women. These findings agrees with
(Mukuma & Kasonka, 2003) that Human resource limitations that included nursing shortages
and inadequate supportive supervision contributes to poor ANC that eventually add on VVF
prevalence rates.
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